MUMBAI: With the Insurance Regulatory and Development Authority ( IRDA) outlining draft norms for the health insurance sector, policyholders can expect clarity on critical issues like claim settlement and increase in renewal premiums. Many policyholders were in the dark in the absence of standard, regulator-mandated settlement practices.

There have been cases where the claim disbursement was delayed by up to six months. IRDA's latest move follows a series of court orders against health insurers pertaining to claim settlement. The regulator had promised to frame guidelines on matters concerning health insurance claims.

If finalised in their current form, the guidelines could ensure that policyholders do not have to wait beyond 30 days for their reimbursement claims to be processed. 'On receipt of complete documents, an insurer shall within a period of 30 days offer a settlement of the claim to the insured.

If the insurer, for any reasons to be recording in writing and communicated to the insured, decides to reject a claim under the policy, it shall do so within a period of 30 days from the receipt of complete documents,' states the provision on claim settlement.

In addition, the insurance regulator has also sought to standardise the operations of third-party administrators (TPA) who play a key role in processing the claims. As per the proposed provision, the TPAs will have to compulsorily divulge the rationale behind claim rejection.